Safe Motherhood Clinical Skills: A Self-Paced Learning Intervention in Ghana

Setting The Stage

Ghana’s Ministry of Health (MOH) was committed to scaling-up post abortion care/life-saving skills/family planning (PAC/LSS/FP) services as part of the National Safe Motherhood Program to reduce high levels of maternal and neonatal mortality and morbidity. Maternal mortality was estimated at 740/100,000 live births in 1998, according to the Ghana Demographic and Health Survey (DHS), (2003). The risk of unwanted pregnancy in Ghana is also high. Although the use of modern contraceptive methods has increased substantially over the last decade, unmet need for family planning was still 34 percent for women of reproductive age. In addition, 36 percent of women interviewed for the DHS stated that their last pregnancy was either unwanted or mistimed, with increased percentages among younger women.

The strategy for expanding and scaling up PAC/LSS/FP services in Ghana was built on a pilot project implemented in three regions and several key lessons learned during the pilot about training health care providers. Notably, in traditional training, trainees were away from their facilities for a substantial amount of time (at least 3 weeks, all at once), thus restricting access to services at their clinics, and many trainees were not able to complete their practical training due to a combination of low numbers of appropriate clients/patients and the presence of multiple trainees at the training sites at one time. A Self-Paced Learning (SPL) approach was designed to address these issues, as well as the significant challenge of sustainability. The goal was to establish an effective approach to preparing health care providers to offer PAC/LSS/FP services consistent with performance expectations and service standards that could be sustained within the social and economic realities of Ghana. Traditional training approaches had failed at doing this, and the need for this training remained.